Conceptual framework for the design, implementation and validation of psychomotor skills’ assessment systems in minimally invasive surgery

Las técnicas de cirugía de mínima invasión (CMI) se están consolidando hoy en día como alternativa a la cirugía tradicional, debido a sus numerosos beneficios para los pacientes. Este cambio de paradigma implica que los cirujanos deben aprender una serie de habilidades distintas de aquellas requeridas en cirugía abierta. El entrenamiento y evaluación de estas habilidades se ha convertido en una de las mayores preocupaciones en los programas de formación de cirujanos, debido en gran parte a la presión de una sociedad que exige cirujanos bien preparados y una reducción en el número de errores médicos. Por tanto, se está prestando especial atención a la definición de nuevos programas que permitan el entrenamiento y la evaluación de las habilidades psicomotoras en entornos seguros antes de que los nuevos cirujanos puedan operar sobre pacientes reales. Para tal fin, hospitales y centros de formación están gradualmente incorporando instalaciones de entrenamiento donde los residentes puedan practicar y aprender sin riesgos. Es cada vez más común que estos laboratorios dispongan de simuladores virtuales o simuladores físicos capaces de registrar los movimientos del instrumental de cada residente. Estos simuladores ofrecen una gran variedad de tareas de entrenamiento y evaluación, así como la posibilidad de obtener información objetiva de los ejercicios. Los diferentes estudios de validación llevados a cabo dan muestra de su utilidad; pese a todo, los niveles de evidencia presentados son en muchas ocasiones insuficientes. Lo que es más importante, no existe un consenso claro a la hora de definir qué métricas son más útiles para caracterizar la pericia quirúrgica. El objetivo de esta tesis doctoral es diseñar y validar un marco de trabajo conceptual para la definición y validación de entornos para la evaluación de habilidades en CMI, en base a un modelo en tres fases: pedagógica (tareas y métricas a emplear), tecnológica (tecnologías de adquisición de métricas) y analítica (interpretación de la competencia en base a las métricas). Para tal fin, se describe la implementación práctica de un entorno basado en (1) un sistema de seguimiento de instrumental fundamentado en el análisis del vídeo laparoscópico; y (2) la determinación de la pericia en base a métricas de movimiento del instrumental. Para la fase pedagógica se diseñó e implementó un conjunto de tareas para la evaluación de habilidades psicomotoras básicas, así como una serie de métricas de movimiento. La validación de construcción llevada a cabo sobre ellas mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. Adicionalmente, los resultados obtenidos en la validación de apariencia fueron en general positivos en todos los grupos considerados (noveles, residentes, expertos). Para la fase tecnológica, se introdujo el EVA Tracking System, una solución para el seguimiento del instrumental quirúrgico basado en el análisis del vídeo endoscópico. La precisión del sistema se evaluó a 16,33ppRMS para el seguimiento 2D de la herramienta en la imagen; y a 13mmRMS para el seguimiento espacial de la misma. La validación de construcción con una de las tareas de evaluación mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. La validación concurrente con el TrEndo® Tracking System por su parte presentó valores altos de correlación para 8 de las 9 métricas analizadas. Finalmente, para la fase analítica se comparó el comportamiento de tres clasificadores supervisados a la hora de determinar automáticamente la pericia quirúrgica en base a la información de movimiento del instrumental, basados en aproximaciones lineales (análisis lineal discriminante, LDA), no lineales (máquinas de soporte vectorial, SVM) y difusas (sistemas adaptativos de inferencia neurodifusa, ANFIS). Los resultados muestran que en media SVM presenta un comportamiento ligeramente superior: 78,2% frente a los 71% y 71,7% obtenidos por ANFIS y LDA respectivamente. Sin embargo las diferencias estadísticas medidas entre los tres no fueron demostradas significativas. En general, esta tesis doctoral corrobora las hipótesis de investigación postuladas relativas a la definición de sistemas de evaluación de habilidades para cirugía de mínima invasión, a la utilidad del análisis de vídeo como fuente de información y a la importancia de la información de movimiento de instrumental a la hora de caracterizar la pericia quirúrgica. Basándose en estos cimientos, se han de abrir nuevos campos de investigación que contribuyan a la definición de programas de formación estructurados y objetivos, que puedan garantizar la acreditación de cirujanos sobradamente preparados y promocionen la seguridad del paciente en el quirófano. Abstract Minimally invasive surgery (MIS) techniques have become a standard in many surgical sub-specialties, due to their many benefits for patients. However, this shift in paradigm implies that surgeons must acquire a complete different set of skills than those normally attributed to open surgery. Training and assessment of these skills has become a major concern in surgical learning programmes, especially considering the social demand for better-prepared professionals and for the decrease of medical errors. Therefore, much effort is being put in the definition of structured MIS learning programmes, where practice with real patients in the operating room (OR) can be delayed until the resident can attest for a minimum level of psychomotor competence. To this end, skills’ laboratory settings are being introduced in hospitals and training centres where residents may practice and be assessed on their psychomotor skills. Technological advances in the field of tracking technologies and virtual reality (VR) have enabled the creation of new learning systems such as VR simulators or enhanced box trainers. These systems offer a wide range of tasks, as well as the capability of registering objective data on the trainees’ performance. Validation studies give proof of their usefulness; however, levels of evidence reported are in many cases low. More importantly, there is still no clear consensus on topics such as the optimal metrics that must be used to assess competence, the validity of VR simulation, the portability of tracking technologies into real surgeries (for advanced assessment) or the degree to which the skills measured and obtained in laboratory environments transfer to the OR. The purpose of this PhD is to design and validate a conceptual framework for the definition and validation of MIS assessment environments based on a three-pillared model defining three main stages: pedagogical (tasks and metrics to employ), technological (metric acquisition technologies) and analytical (interpretation of competence based on metrics). To this end, a practical implementation of the framework is presented, focused on (1) a video-based tracking system and (2) the determination of surgical competence based on the laparoscopic instruments’ motionrelated data. The pedagogical stage’s results led to the design and implementation of a set of basic tasks for MIS psychomotor skills’ assessment, as well as the definition of motion analysis parameters (MAPs) to measure performance on said tasks. Validation yielded good construct results for parameters such as time, path length, depth, average speed, average acceleration, economy of area and economy of volume. Additionally, face validation results showed positive acceptance on behalf of the experts, residents and novices. For the technological stage the EVA Tracking System is introduced. EVA provides a solution for tracking laparoscopic instruments from the analysis of the monoscopic video image. Accuracy tests for the system are presented, which yielded an average RMSE of 16.33pp for 2D tracking of the instrument on the image and of 13mm for 3D spatial tracking. A validation experiment was conducted using one of the tasks and the most relevant MAPs. Construct validation showed significant differences for time, path length, depth, average speed, average acceleration, economy of area and economy of volume; especially between novices and residents/experts. More importantly, concurrent validation with the TrEndo® Tracking System presented high correlation values (>0.7) for 8 of the 9 MAPs proposed. Finally, the analytical stage allowed comparing the performance of three different supervised classification strategies in the determination of surgical competence based on motion-related information. The three classifiers were based on linear (linear discriminant analysis, LDA), non-linear (support vector machines, SVM) and fuzzy (adaptive neuro fuzzy inference systems, ANFIS) approaches. Results for SVM show slightly better performance than the other two classifiers: on average, accuracy for LDA, SVM and ANFIS was of 71.7%, 78.2% and 71% respectively. However, when confronted, no statistical significance was found between any of the three. Overall, this PhD corroborates the investigated research hypotheses regarding the definition of MIS assessment systems, the use of endoscopic video analysis as the main source of information and the relevance of motion analysis in the determination of surgical competence. New research fields in the training and assessment of MIS surgeons can be proposed based on these foundations, in order to contribute to the definition of structured and objective learning programmes that guarantee the accreditation of well-prepared professionals and the promotion of patient safety in the OR.

Dysfunctional and compensatory duality in mild cognitive impairment during a continuous recognition memory task

One of the current issues of debate in the study of mild cognitive impairment (MCI) is deviations of oscillatory brain responses from normal brain states and its dynamics. This work aims to characterize the differences of power in brain oscillations during the execution of a recognition memory task in MCI subjects in comparison with elderly controls. Magnetoencephalographic (MEG) signals were recorded during a continuous recognition memory task performance. Oscillatory brain activity during the recognition phase of the task was analyzed by wavelet transform in the source space by means of minimum norm algorithm. Both groups obtained a 77% hit ratio. In comparison with healthy controls, MCI subjects showed increased theta (p < 0.001), lower beta reduction (p < 0.001) and decreased alpha and gamma power (p < 0.002 and p < 0.001 respectively) in frontal, temporal and parietal areas during early and late latencies. Our results point towards a dual pattern of activity (increase and decrease) which is indicative of MCI and specific to certain time windows, frequency bands and brain regions. These results could represent two neurophysiological sides of MCI. Characterizing these opposing processes may contribute to the understanding of the disorder.

Relevance of motion-related assessment metrics in laparoscopic surgery

INTRODUCTION: Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills, as well as their correlation with the different abilities sought to measure. METHODS: A framework for task definition and metric analysis is proposed. An explorative survey was first conducted with a board of experts to identify metrics to assess basic psychomotor skills. Based on the output of that survey, three novel tasks for surgical assessment were designed. Face and construct validation study was performed, with focus on motion-related metrics. Tasks were performed by 42 participants (16 novices, 22 residents and 4 experts). Movements of the laparoscopic instruments were registered with the TrEndo tracking system and analyzed. RESULTS: Time, path length and depth showed construct validity for all three tasks. Motion smoothness and idle time also showed validity for tasks involving bi-manual coordination and tasks requiring a more tactical approach respectively. Additionally, motion smoothness and average speed showed a high internal consistency, proving them to be the most task-independent of all the metrics analyzed. CONCLUSION: Motion metrics are complementary and valid for assessing basic psychomotor skills, and their relevance depends on the skill being evaluated. A larger clinical implementation, combined with quality performance information, will give more insight on the relevance of the results shown in this study.

Handmade Task Tracking Applied to Cognitive Rehabilitation

This article presents research focused on tracking manual tasks that are applied in cognitive rehabilitation so as to analyze the movements of patients who suffer from Apraxia and Action Disorganization Syndrome (AADS). This kind of patients find executing Activities of Daily Living (ADL) too difficult due to the loss of memory and capacity to carry out sequential tasks or the impossibility of associating different objects with their functions. This contribution is developed from the work of Universidad Politécnica de Madrid and Technical University of Munich in collaboration with The University of Birmingham. The KinectTM for Windows© device is used for this purpose. The data collected is compared to an ultrasonic motion capture system. The results indicate a moderate to strong correlation between signals. They also verify that KinectTM is very suitable and inexpensive. Moreover, it turns out to be a motion-capture system quite easy to implement for kinematics analysis in ADL.

Accelerating FPGA-based evolution of wavelet transform filters by optimized task scheduling

Adaptive embedded systems are required in various applications. This work addresses these needs in the area of adaptive image compression in FPGA devices. A simplified version of an evolution strategy is utilized to optimize wavelet filters of a Discrete Wavelet Transform algorithm. We propose an adaptive image compression system in FPGA where optimized memory architecture, parallel processing and optimized task scheduling allow reducing the time of evolution. The proposed solution has been extensively evaluated in terms of the quality of compression as well as the processing time. The proposed architecture reduces the time of evolution by 44% compared to our previous reports while maintaining the quality of compression unchanged with respect to existing implementations. The system is able to find an optimized set of wavelet filters in less than 2 min whenever the input type of data changes.

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Purpose: Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Methods: Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results: In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions: Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

Distributed bees algorithm for task allocation in swarm of robots

In this paper, we propose the distributed bees algorithm (DBA) for task allocation in a swarm of robots. In the proposed scenario, task allocation consists in assigning the robots to the found targets in a 2-D arena. The expected distribution is obtained from the targets' qualities that are represented as scalar values. Decision-making mechanism is distributed and robots autonomously choose their assignments taking into account targets' qualities and distances. We tested the scalability of the proposed DBA algorithm in terms of number of robots and number of targets. For that, the experiments were performed in the simulator for various sets of parameters, including number of robots, number of targets, and targets' utilities. Control parameters inherent to DBA were tuned to test how they affect the final robot distribution. The simulation results show that by increasing the robot swarm size, the distribution error decreased.

UPM Activities on the STLs processing (Task 6.2) and the generation of DPA cross section library up to 150 MeV (Task 4.1)

Generation of a complete damage energy and dpa cross section library up to 150 MeVbased on JEFF- 3.1.1 and suitable approximations (UPM) Postprocessing of photonuclear libraries (by CCFE) and thermal scattering  tables (by UPM) at the backend of the calculational system (CCFE/UPM)

Response threshold models and stochastic learning automata for self-coordination of heterogeneous multi-task distribution in multi-robot systems.

This paper focuses on the general problem of coordinating multiple robots. More specifically, it addresses the self-selection of heterogeneous specialized tasks by autonomous robots. In this paper we focus on a specifically distributed or decentralized approach as we are particularly interested in a decentralized solution where the robots themselves autonomously and in an individual manner, are responsible for selecting a particular task so that all the existing tasks are optimally distributed and executed. In this regard, we have established an experimental scenario to solve the corresponding multi-task distribution problem and we propose a solution using two different approaches by applying Response Threshold Models as well as Learning Automata-based probabilistic algorithms. We have evaluated the robustness of the algorithms, perturbing the number of pending loads to simulate the robot’s error in estimating the real number of pending tasks and also the dynamic generation of loads through time. The paper ends with a critical discussion of experimental results.

Supervised classification of minimally invasive surgery psychomotor competence based on instruments motion analysis

Background Objective assessment of psychomotor skills has become an important challenge in the training of minimally invasive surgical (MIS) techniques. Currently, no gold standard defining surgical competence exists for classifying residents according to their surgical skills. Supervised classification has been proposed as a means for objectively establishing competence thresholds in psychomotor skills evaluation. This report presents a study comparing three classification methods for establishing their validity in a set of tasks for basic skills’ assessment. Methods Linear discriminant analysis (LDA), support vector machines (SVM), and adaptive neuro-fuzzy inference systems (ANFIS) were used. A total of 42 participants, divided into an experienced group (4 expert surgeons and 14 residents with >10 laparoscopic surgeries performed) and a nonexperienced group (16 students and 8 residents with <10 laparoscopic surgeries performed), performed three box trainer tasks validated for assessment of MIS psychomotor skills. Instrument movements were captured using the TrEndo tracking system, and nine motion analysis parameters (MAPs) were analyzed. The performance of the classifiers was measured by leave-one-out cross-validation using the scores obtained by the participants. Results The mean accuracy performances of the classifiers were 71 % (LDA), 78.2 % (SVM), and 71.7 % (ANFIS). No statistically significant differences in the performance were identified between the classifiers. Conclusions The three proposed classifiers showed good performance in the discrimination of skills, especially when information from all MAPs and tasks combined were considered. A correlation between the surgeons’ previous experience and their execution of the tasks could be ascertained from results. However, misclassifications across all the classifiers could imply the existence of other factors influencing psychomotor competence.

Temporal task allocation in periodic environments. An approach based on synchronization

In this paper, we study a robot swarm that has to perform task allocation in an environment that features periodic properties. In this environment, tasks appear in different areas following periodic temporal patterns. The swarm has to reallocate its workforce periodically, performing a temporal task allocation that must be synchronized with the environment to be effective. We tackle temporal task allocation using methods and concepts that we borrow from the signal processing literature. In particular, we propose a distributed temporal task allocation algorithm that synchronizes robots of the swarm with the environment and with each other. In this algorithm, robots use only local information and a simple visual communication protocol based on light blinking. Our results show that a robot swarm that uses the proposed temporal task allocation algorithm performs considerably more tasks than a swarm that uses a greedy algorithm.

Task-based telemanipulation for maintenance in large scientific facilities

This thesis presents a task-oriented approach to telemanipulation for maintenance in large scientific facilities, with specific focus on the particle accelerator facilities at European Organization for Nuclear Research (CERN) in Geneva, Switzerland and GSI Helmholtz Centre for Heavy Ion Research (GSI) in Darmstadt, Germany. It examines how telemanipulation can be used in these facilities and reviews how this differs from the representation of telemanipulation tasks within the literature. It provides methods to assess and compare telemanipulation procedures as well a test suite to compare telemanipulators themselves from a dexterity perspective. It presents a formalisation of telemanipulation procedures into a hierarchical model which can be then used as a basis to aid maintenance engineers in assessing tasks for telemanipulation, and as the basis for future research. The model introduces a new concept of Elemental Actions as the building block of telemanipulation movements and incorporates the dependent factors for procedures at a higher level of abstraction. In order to gain insight into realistic tasks performed by telemanipulation systems within both industrial and research environments a survey of teleoperation experts is presented. Analysis of the responses is performed from which it is concluded that there is a need within the robotics community for physical benchmarking tests which are geared towards evaluating the dexterity of telemanipulators for comparison of their dexterous abilities. A three stage test suite is presented which is designed to allow maintenance engineers to assess different telemanipulators for their dexterity. This incorporates general characteristics of the system, a method to compare kinematic reachability of multiple telemanipulators and physical test setups to assess dexterity from a both a qualitative perspective and measurably by using performance metrics. Finally, experimental results are provided for the application of the proposed test suite onto two telemanipulation systems, one from a research setting and the other within CERN. It describes the procedure performed and discusses comparisons between the two systems, as well as providing input from the expert operator of the CERN system.

Thermal Scattering Libraries Processing (F4E, Task 6.2)

Presentación del trabajo realizado en el marco del proyecto F4E, sobre el procesamiento de librerías de dispersión térmica de neutrones en formato ACE para su uso con el código MCNP. Se presentan tanto los métodos y procedimientos empleados, como los resultados y diferencias entre las distintas fuentes de datos.

DAEDALUS at SemEval-2014 Task 9: Comparing approaches for sentiment analysis in twitter

This paper describes our participation at SemEval- 2014 sentiment analysis task, in both contextual and message polarity classification. Our idea was to com- pare two different techniques for sentiment analysis. First, a machine learning classifier specifically built for the task using the provided training corpus. On the other hand, a lexicon-based approach using natural language processing techniques, developed for a ge- neric sentiment analysis task with no adaptation to the provided training corpus. Results, though far from the best runs, prove that the generic model is more robust as it achieves a more balanced evaluation for message polarity along the different test sets.

Context-awareness in task automation services by distributed event processing

Everybody has to coordinate several tasks everyday, usually in a manual manner. Recently, the concept of Task Automation Services has been introduced to automate and personalize the task coordination problem. Several user centered platforms and applications have arisen in the last years, that let their users configure their very own automations based on third party services. In this paper, we propose a new system architecture for Task Automation Services in a heterogeneous mobile, smart devices, and cloud services environment. Our architecture is based on the novel idea to employ distributed Complex Event Processing to implement innovative mixed execution profiles. The major advantage of the approach is its ability to incorporate context-awareness and real-time coordination in Task Automation Services.